Systems, devices, and methods for guiding surgical devices into bone

ABSTRACT

Devices, systems, and methods are generally provided for guiding surgical devices into a desired location and orientation in a bone. In general, the devices can include an elongate guide, a sleeve having an inner lumen therethrough for seating the guide, and a locking mechanism configured to lock a position of the guide with respect to the sleeve. The guide can have a distal, bone-engaging portion that can be laterally offset from an intermediate portion of the guide by a predetermined distance and that can extend distally beyond the sleeve to contact a bony structure. The guide can thus orient and stabilize the sleeve at the predetermined distance from the bony structure to provide for the delivery of one or more surgical devices through the sleeve and into the bone at a desired location and orientation, without requiring a surgeon to actually view the surgical site.

FIELD

The present disclosure relates to systems, devices, and methods forguiding one or more surgical devices to a desired location andorientation with respect to a bone.

BACKGROUND

Many surgical procedures involve placing an implant into bone. Forexample, when fixing a relationship between adjacent bones or bonesegments, one common procedure involves driving one or more screws intothe bone(s) to serve as an anchoring device for a fixation element, suchas a relatively rigid fixation rod. The fixation element can have apredetermined contour that has been designed according to the propertiesof the target implantation site, and once installed, can hold the bonesor bone segments in a desired spatial relationship until desired healingor fusion has taken place.

In many such procedures, the implant can be placed in the bone at adesired location and/or orientation by driving the implant into thebone. In some procedures, it may be necessary to place the implant intoa location near the edge of the bone, for example where the bone has asmall width or where the implant is being used to anchor the bone to anadjacent bone. However, it is often desirable to not drive an implantinto a portion of a bone that is near the edge of the bone because theimplant might cause the edge of the bone to fracture and/or the implantmay skive off the edge of the bone. Inserting the implant into thedesired position can be complicated by a variety of factors, e.g., theadjacent anatomy, the small size of the bone, irregularities in theshape of the bone, etc. In minimally invasive surgeries, which arebecoming increasingly popular, the difficulties with accurately locatingan appropriate location and orientation for an implant within the bonecan be exacerbated. Traditionally, positional determination can beperformed by imaging techniques such as X-rays, even during opensurgery, but this can require temporary cessation of the procedure andmay need to be performed multiple times throughout a single procedure,thereby increasing a risk related to the use of X-rays.

One particularly complex anatomy for inserting a bone implant is theshoulder joint, for example during a glenoid fixation procedure. Duringtraditional glenoid fixation procedures, one or more bone screws areinserted into the shoulder blade adjacent to the glenoid rim. Theglenoid rim can be small, difficult to access, and can have an irregularsurface, making it difficult for surgeons to insert a screw into theglenoid rim at a location that is far enough away from the edge toprevent the screw from damaging the shoulder blade. Although thisprocedure is traditionally performed in open surgery, recently there hasbeen a greater demand to provide for a minimally invasive form ofglenoid fixation, which further complicates correct placement of thebone screw in the shoulder blade. Another procedure involving complexanatomies that complicate placement of bone implants is a bone blockprocedure, in which a bone graft is used to reconstruct a joint surface.

Accordingly, there is a need for devices, systems, and methods tofacilitate guiding surgical devices such as a bone implant to a desiredlocation and orientation in the bone.

SUMMARY

Systems, devices, and methods are generally provided for guidingsurgical devices into a bone. In one exemplary embodiment, a surgicalguide system is provided that includes a sleeve having an inner lumenextending therethrough, a guide that is removably insertable into theinner lumen of the sleeve, and a locking mechanism configured tomaintain a location of the guide with respect to the sleeve in a fixedposition in which a portion of the guide extends through the inner lumenand the distal tip extends distally beyond a distal-most end of thesleeve. The guide can have a distal tip that is laterally offset from acentral longitudinal axis of the inner lumen by a predetermineddistance, which, in some embodiments, can be in the range of about 3millimeters to about 12 millimeters.

In some embodiments, the locking mechanism can include a trocar that isremovably insertable into the inner lumen of the sleeve to engage theguide and maintain the guide in the fixed position. The trocar caninclude at least one guide passageway configured to receive the guidetherein. The at least one guide passageway can have one or more wallsconfigured to engage the guide to maintain the guide in the fixedposition. The trocar can further include a K-wire passageway configuredto slidably receive a K-wire that is configured to be inserted intobone. The K-wire passageway can extend through a cross-sectional centerof the trocar and the at least one guide passageway can be disposedradially outward from a diameter of the K-wire passageway. Additionallyor alternatively, the locking mechanism can include a slot formed in theguide and configured to engage the guide to maintain it in the fixedposition.

The guide can have a proximal portion that comprises a stopper and thatextends proximally beyond a proximal-most end of the sleeve when theguide is in the fixed position. In some embodiments, the guide can bemade from a shape-memory material or flexible material. In still furtherembodiments, the sleeve can have at least one slot extending through asidewall thereof, with the slot being configured to allow the guide topass therethrough.

In another aspect, a wire guide is provided for providing a stabilizingoffset for drilling a hole in bone. The wire guide can include a distalportion, an intermediate portion, and a proximal portion. The distalportion can be laterally offset from the intermediate portion by apredetermined distance and/or can have a shape that corresponds to ashape of an edge of a bone with which the guide is configured to be usedto create a stabilizing offset. In this way, when the distal portionengages the bone, the wire guide establishes an offset position at whicha hole is to be drilled in the bone engaged by the distal portion. Theproximal portion can have a loop formed therein.

Further, the distal portion can be formed from a shape memory materialand/or can have an S-shape. In some embodiments, the wire can beconfigured to be integrally formed with a sleeve having an inner lumenextending therethrough such that the distal portion of the wire extendsdistally beyond a distal-most end of the sleeve.

In another aspect, a surgical method is provided that includes insertinga sleeve through an opening in a patient's body and adjacent to a bone,passing a guide distally through an inner lumen of the sleeve until adistal tip of the guide extends distally beyond a distal-most end of thesleeve, rotating the guide such that its distal tip is disposed outsideof a diameter of the sleeve, placing a guide placement surface of theguide distal tip against an edge of the bone such that the inner lumenof the sleeve is proximate to a bore formation location on the bone thatis offset from the edge of the bone, and forming a bore in the bone atthe bore formation location. In some embodiments, the bone is a scapulaand the edge of the bone is the glenoid rim.

In some embodiments, the method can further include securing a fixedlocation of the guide with respect to the sleeve after the distal tip ofthe guide extends distally beyond the distal-most end of the sleeve. Thesecuring can include inserting a trocar distally through the innerlumen. Further, the method can include inserting a K-wire distallythrough the trocar and into the bone and, in some embodiments, removingthe guide and the trocar from the sleeve once the K-wire has been placedin the bone. Additionally or alternatively, the method can furtherinclude adjusting a location of the distal tip with respect to a mainbody of the guide after the guide has been passed distally through thesleeve.

The steps of the method can be performed in any order. For example, insome embodiments, the sleeve and the guide can be inserted into thepatient's body simultaneously. In other embodiments, the sleeve can beinserted into the patient's body before the guide, while in still otherembodiments the guide can be inserted into the patient's body before thesleeve.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of a guide system;

FIG. 2 is a side view of a guide from the guide system of FIG. 1;

FIG. 3 is a cross-sectional view of a guide and sleeve of the guidesystem of FIG. 1 taken along the line A-A, the guide being in acompressed configuration;

FIG. 4 is a cross-sectional view of the guide and sleeve of FIG. 3, theguide being in an expanded configuration;

FIG. 5 is a perspective view of a sleeve and a handle from the guidesystem of FIG. 1;

FIG. 6A is a side view of a trocar from the system of FIG. 1;

FIG. 6B is a cross-sectional view of the trocar of FIG. 6A taken fromline B-B;

FIG. 7A is a perspective view of another embodiment of a guide system;

FIG. 7B is a side view of the guide system of FIG. 7A;

FIG. 7C is a front view of the guide system of FIG. 7A;

FIG. 8A is a perspective view of a sleeve and a handle of the guidesystem of FIG. 7A;

FIG. 8B is a side view of the sleeve and the handle of FIG. 8A;

FIG. 8C is a front view of the sleeve and the handle of FIG. 8A;

FIG. 9A is a side view of a distal end of an alternate embodiment of aguide;

FIG. 9B is a side view of a distal end of another alternate embodimentof a guide;

FIG. 9C is a side view of a distal end of another alternate embodimentof a guide;

FIG. 9D is a side view of a distal end of another alternate embodimentof a guide;

FIG. 9E is a side view of a distal end of another alternate embodimentof a guide;

FIG. 9F is a side view of a distal end of another alternate embodimentof a guide; and

FIG. 10 is a perspective view of a step of a method for performing aglenoid fixation procedure using the guide system of FIG. 1.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

In the present disclosure, like-numbered components of the embodimentsgenerally have similar features and/or purposes. Further, to the extentthat linear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the size and shape of the components with which the systems anddevices are being used, the anatomy of the patient, and the methods andprocedures in which the systems and devices will be used. The figuresprovided herein are not necessarily to scale.

Devices, systems, and methods are generally provided for guidingsurgical devices into a desired location and orientation in a bone. Ingeneral, the guide systems can include an elongate guide, a sleevehaving an inner lumen therethrough for seating the guide, and a lockingmechanism configured to lock the guide within the sleeve in a fixedposition. The guide can have a distal, bone-engaging portion that can belaterally offset from an intermediate portion of the guide and aproximal portion that can be configured to indicate and/or to adjust adirection of the lateral offset. The guide can be configured to passdistally through the sleeve until the distal portion of the guideextends beyond a distal end of the sleeve, an intermediate portion ofthe guide extends through the sleeve, and the proximal portion of theguide extends proximally beyond a proximal end of the sleeve. Whenseated within the sleeve in this way, the distal portion of the guidecan extend radially outward beyond an edge of the sleeve and theproximal portion of the guide can be manipulated by a user to orient thedistal portion in a desired angular position, where the guide can beoptionally locked in place by the locking mechanism. Thus positioned,the distal portion of the guide can contact a bony structure, forexample an edge of the bone, to thereby brace the sleeve against thebony structure at a desired location and orientation. The guide canorient and stabilize the sleeve to provide for the delivery of one ormore surgical devices through the sleeve and into the bone at thedesired location and orientation, without requiring a surgeon toactually view the surgical site. The guide can thus be useful forarthroscopic surgery, where surgical devices must pass through smallopenings and around complex anatomy, by providing a large lateral offsetfor the guide with a small diameter sleeve. Where the bone is fractured,the guide can help to hold pieces of the bone together prior to andduring fixation.

One exemplary embodiment of a system 10 for orienting one or moresurgical devices with respect to a bone is illustrated in FIG. 1. Thesystem 10 can include a guide 20, a sleeve 30, and a locking mechanism,as shown a trocar 40. When the system 10 is assembled, the guide 20 canbe configured to extend through a passageway 43 of the trocar 40, whichin turn can be configured to extend through a lumen 32 of the sleeve 30.The trocar 40 can be configured to lock the guide 20 in place within thesleeve 30, such that the guide 20 can orient the sleeve 30 and anydevices passed therethrough at a desired distance and orientation from abony structure that is contacted by the guide 20. While the illustratedembodiment provides for the trocar 40 as the locking mechanism, it willbe appreciated by a person skilled in the art that a variety of otherlocking mechanisms can be used to set a location of the guide 20 withrespect to the sleeve 30. Further, in some embodiments the lockingmechanism can be integrated with the sleeve 30 such that the system 10only includes the guide 20 and the sleeve 30. It will further beappreciated that the use of multiple components for orienting one ormore surgical devices, including the guide 20, the sleeve 30, andoptionally the trocar 40, can enhance the flexibility of the surgicalsystem 10 by providing the option of only using only a subset of thecomponents. Further, as will be explained in detail below, the use ofthe sleeve 30 together with the guide 20 can facilitate delivery of theguide 20 through a small surgical incision while still providing for alarge lateral offset between a location of a bone implant and a bonystructure contacted by the guide 20.

As shown in FIG. 2, the guide 20 can be an elongate body, e.g., a wire,that can include a distal portion 22, a proximal portion 26, and anintermediate portion 24 extending therebetween. The distal portion 22can be any shape and size that facilitates engagement of the distalportion 22 with a bony structure while preventing injury of the boneand/or surrounding tissue. For example, the distal portion 22 can beformed from a semi-rigid material to facilitate passage of the guide 20into a surgical site, and/or the distal end 22 can have a blunt distaltip to help prevent injury to tissue, e.g., cartilage, at the surgicalsite. In the illustrated embodiment, the distal portion 22 forms a flatsurface that is offset from and substantially parallel to theintermediate portion 24. In this way, the distal portion 22 forms anS-shape with respect to the intermediate portion 24. Because the distalportion 22 of the illustrated embodiment is substantially flat, it canhelp to align the guide 20 with a substantially flat portion of thebone. However, it will be appreciated by a person of skill in the artthat the shape of the distal portion 22 can be customized for use with aparticular bony structure and/or with an individual patient's bone. Forexample, the shape of the distal portion 22 can be molded based on animage of a patient's bone structure.

To facilitate delivery of one or more surgical devices at apredetermined distance from the bony structure, at least a part of thedistal portion 22 can be laterally offset from the intermediate portion24 by a predetermined distance D_(G). The distance D_(G) can varyaccording to a patient's anatomy (e.g., child versus adult and/or maleversus female) and/or to a desired offset of the one or more surgicaldevices from the bony structure. In general, the distance D_(G) can beoptimized to allow for the placement of a surgical device far enoughaway from the bony structure, e.g., the edge of the bone, to prevent thedevice from passing through, falling out, or skiving off the bone. Whenused in glenoid fixation procedures, the distance D_(G) can be in arange of about 3 millimeters to about 6 millimeters to facilitateplacement of a bone screw about 3 millimeters to about 6 millimetersaway from the glenoid rim. Similarly, a length L_(D) of the distalportion 22 can be sized to allow for the guide 20 to extend beyond adistal end of the sleeve 30 to reach a bony structure. In general, thelength L_(D) can be in a range of about 3 millimeters to about 30millimeters.

To facilitate delivery of the one or more surgical devices in a desiredangular orientation with respect to the bony structure, the distalportion 22 can be bent to the desired angular orientation with respectto the intermediate portion 24. In this way, where the intermediateportion 24 is seated within the sleeve 30 and the distal portion 22abuts the bony structure, the guide 20 can orient the sleeve 30 at thedesired angular orientation with respect to the bony structure. Devicespassing through the sleeve 30 along a track that is parallel to alongitudinal axis L of the sleeve 30 can thus be oriented at the desiredangular position with respect to the bone. Using the illustratedembodiment of FIGS. 1-2 as an example, the S-shape of the guide 20 canbe used to orient surgical devices passing through the sleeve 30 in asubstantially parallel orientation with respect to a bony structure,e.g., the edge of a bone. Specifically, the distal portion 22 can abut asubstantially flat portion of the edge of the bone, and the intermediateportion 24 can be aligned along the longitudinal axis L of the sleeve30. In this way, the sleeve 30 can be oriented substantially parallel tothe edge of the bone and devices passing through the sleeve 30 can alsobe oriented substantially parallel to the edge of the bone. The parallelalignment of surgical devices with the edge of the bone can beparticularly advantageous for, e.g., inserting a bone screw into thebone in close proximity to the edge of the bone such that the screw doesnot pass through the bone or skive off the bone. It will be appreciatedby a person of skill in the art that the distal and intermediateportions 22, 24 can be oriented at any angular position with respect toone another to achieve any desired angular orientation of surgicaldevices with respect to a bony structure.

To facilitate insertion of the guide 20 into a surgical site, in someembodiments the distal portion 22 can be configured to move between anexpanded configuration, in which an effective width of the guide 20 islarge, and a compressed configuration, in which an effective width ofthe guide 20 is small. For example, as illustrated in FIGS. 3-4, thedistal portion 22 can be biased to the expanded configuration andcapable of being moved to the compressed configuration when acted uponby an external force. In this way, the distal portion 22 can beconfigured to have a small width when passing through the sleeve 30 orother cannulated device, but to have a larger width once it passes outthe distal end of the sleeve 30 or other cannulated device. In theillustrated embodiment, the distal portion 22 can be biased to theS-shape in the expanded configuration, with the distal portion 22 beinglaterally offset from the intermediate portion 24 by the firstpredetermined distance D_(G) (FIG. 4). When disposed within the sleeve30, the distal portion 22 can move to the compressed configuration inwhich the distal portion 22 extends substantially parallel to theintermediate portion 24 in a straight line (FIG. 3). Thus, in theexpanded configuration, the guide 20 can have an effective width D_(G),but in the compressed configuration, the guide 20 can have an effectivewidth equal to a diameter of the guide 20.

The intermediate portion 24 of the guide 20 extends between the proximaland distal portions 26, 22 and can be configured to be at leastpartially seated within the lumen 32 of the sleeve 30. In theillustrated embodiment, the intermediate portion 24 is substantiallystraight and has a length L_(I) that is substantially equal to a lengthL_(S) of the sleeve 30, such that the entire intermediate portion 24 canbe enclosed within the lumen 32 of the sleeve 30. However, the lengthL_(I) can be less than the length L_(S), to allow for at least a part ofthe intermediate portion 24 to extend proximally and/or distally of thesleeve 30.

The proximal portion 26 can be configured indicate an orientation of thedistal portion 22 and/or to change the orientation of the distal portion22, which can be useful when the distal portion 22 is inserted throughan incision into the patient's body and is not visible to the user. Inthe illustrated embodiment, the proximal portion 26 is shaped as a loophaving a major axis A_(M) that is parallel to a direction of offset ofthe distal portion 22 from the intermediate portion 24. Further, theloop is formed on the same side of the guide 20 as the distal portion22. Thus, the user can know the direction of offset of the distalportion 22 by observing the direction of offset of the loop formed bythe proximal portion 26, which corresponds to the offset of the distalportion 22. In this way, where the proximal portion 26 is disposedexternally of a patient's body, the user can know the direction of thelateral offset of the distal portion 22 within the patient's bodywithout being able to see the distal portion 22. This feature can beparticularly useful for minimally invasive surgical procedures, in whichthe guide 20 is inserted through a portal to minimize trauma incurred bythe surgery. It will be appreciated by a person skilled in the art thatthe proximal portion 26 can include any direction indication feature,such as an etching or marking on an exterior surface of the proximalportion 26.

The proximal portion 26 can be configured for gripping by a user to helpmanipulate the guide 20, particularly where the proximal portion 26 isconfigured to change an orientation of the distal portion 22. In theillustrated embodiment, the user can insert one or more fingers throughthe loop formed by the proximal portion 26 to grip the proximal portion26 between the user's one or more fingers and, e.g., the user's thumb.In some embodiments, the proximal portion 26 can serve as a stop toprevent passage of the guide 20 into a patient's body beyond a desireddistance. In the illustrated embodiment, for example, a diameter of theloop is large enough to prevent distal advancement of the guide 20through the sleeve 30 when the loop abuts a proximal end of the sleeve30.

The guide 20 can be formed from any one or more materials that aresuitable for insertion into the patient's body. In some embodiments, thedistal, intermediate, and proximal portions 22, 24, 26 can be made fromdifferent materials than one another and/or can be made from differentmaterials along a length thereof. For example, in some embodiments, atleast the distal portion 22 can be formed from a shape memory material,which can include a single material or any combination of materials, tocause the distal portion 22 to be laterally biased away from theintermediate portion 24 and/or to assume a shape that facilitatesengagement with bone. In other words, the distal portion 22 can flareaway from the intermediate portion 24 in the expanded configuration.Non-limiting examples of shape memory materials includecopper-zinc-aluminum-nickel alloys, copper-aluminum-nickel alloys,nickel-titanium alloys such as Nitinol, thermoplastic materials such asNylon or Nylon blends, and shape memory polymers such as Veriflex™. Theshape memory material can facilitate advancement of the guide 20 intotissue by allowing for at least the distal portion 22 of the guide 20 tobe deformed or bent into the compressed configuration in which the guide20 has a smaller width than a width thereof in the expandedconfiguration, while also allowing the distal portion 22 of the guide 20to automatically move from the compressed configuration to the expandedconfiguration. It will be appreciated by a person skilled in the artthat any portion of the guide 20, including the entire guide 20, can bemade from one or more shape memory materials.

In some embodiments the intermediate portion 24 can be made from any oneor more materials that are less flexible than the proximal portion 26,and/or can be formed to have a hardness gradient that increases from adistal end to a proximal end thereof. In other embodiments, the distalportion 22 can be formed from one or more materials configured to avoiddamage to soft tissue surrounding the target bone to be contacted by thedistal portion 22. For example, the distal portion 22 can be formed fromone or more flexible materials and/or can be formed from one or moresmooth materials without sharp edges. By way of non-limiting examples,the guide 20 can be made from one or more materials including Nitinol,Gum Metal, spring steel, stainless steel, Titanium and polymers.

It will be appreciated by a person skilled in the art that the guide 20can comprise only the distal portion 22 or only the distal andintermediate portions 22, 24. Also, in some embodiments, at least aportion of the guide 20 can be integrally formed with or permanentlyattached to the sleeve 30. For example, the guide can comprise only thedistal portion 22. In such embodiments, the guide can be integrallyformed with the distal end of the sleeve 30 such that it always extendsdistally beyond the sleeve 30, or it can be configured to be selectivelyextended distally beyond the sleeve 30 and retracted proximally into thesleeve 30, e.g., by an actuation mechanism located on a proximal portionof the sleeve 30. In either aspect, the guide is thus inherently lockedin a fixed radial orientation with respect to the sleeve 30. Thus, adirection of the guide can be indicated by any indication feature, e.g.,an arrow, etched onto the proximal portion of the sleeve 30.

The sleeve 30 can have a variety of sizes, shapes, and configurations.Generally, the sleeve 30 can be configured to be inserted at leastpartially into a body of a patient. By way of non-limiting example, thesleeve 30 can have a small outer diameter D_(o) to facilitate insertionof the sleeve 30 into a patient's body, particularly during minimallyinvasive procedures and/or with complex anatomies. As shown in FIG. 5,the sleeve 30 has a cylindrical shape, but the sleeve 30 can have anyother shape and a variety of outer diameters along the longitudinallength thereof. At least a distal portion of the sleeve 30 can beconstructed of one or more substantially rigid materials to facilitateinsertion into a patient, although a portion of the sleeve 30, e.g., aproximal portion, can be flexible. In some embodiments, the sleeve 30can have one or more features thereon to facilitate endoscopic viewingof a surgical procedure. In the illustrated embodiment, the sleeve 30has opposed cutouts 35 a, 35 b adjacent to the distal end of the sleeve30 to serve as a viewing window for an endoscope passed through thesleeve 30.

An inner lumen 32 can extend along an entire longitudinal length L ofthe sleeve 30 such that the shaft 34 has a cannulated interior. Thelumen 32 can be configured to facilitate the passage and/or use ofsurgical devices inserted into a patient's body therethrough, e.g., across-section of the lumen 32 can be shaped and sized to accommodateaxial sliding of one or more surgical devices therethrough. For example,the lumen 32 can have an inner diameter D_(I) that is large enough toallow for the guide 20 to pass therethrough. Where the guide 20 iscapable of moving between compressed and expanded configurations, thediameter D_(I) can be small enough to compress the distal portion 22 ofthe guide 20 into the compressed configuration as the distal portion 22passes through the sleeve 30, as shown in FIG. 4. In some embodiments,the lumen 32 can be large enough to seat the trocar 40 therein such thatthe trocar 40 can slide axially within the lumen 32. The lumen 32 in theillustrated embodiment has a cylindrical shape and only one innerdiameter D_(I), but the lumen 32 can have any other shape and varyingdiameters along a length thereof to accommodate one or more lockingmechanisms for holding the guide 20 in place with respect to the sleeve30.

In some embodiments, a handle 50 can be attached to a proximal end ofthe sleeve 30 to facilitate insertion of the sleeve 30 into a patient'sbody. The handle 50 can be attached to the sleeve 30 either permanently,for instance by being integrally formed with the sleeve 30, or it can beremovably attached to the sleeve 30. The handle 50 can be configured ina variety of ways to improve the user's ability to deliver and/orposition one or more surgical devices through the sleeve 30. Forexample, the handle 50 can have various features thereon to facilitategripping, at least along the proximal portion thereof (e.g., ribs,protrusions, etc.), and/or can be formed from one or more materials thatfacilitate gripping. In the illustrated embodiment, the handle 50 isformed to provide for a pistol grip, although it will be appreciated bya person skilled in the art that the handle 50 can be any shape thatfacilitates gripping, e.g., a loop, a bulb, etc. In some embodiments,the handle 50 can be specially designed for ergonomic gripping.

To further facilitate delivery of one or more surgical devices throughthe sleeve 30, a portion of the handle 50 can have at least one depthindication feature formed thereon that provides information about adepth of devices inserted through the sleeve 30, which can beparticularly useful in minimally invasive procedures where a distalportion of a device is inserted into the patient's body is not visibleto the user. For example, sets of demarcation lines 56 a, 56 b extendingproximally beyond the shaft 30 along arms 58 a, 58 b of the handle 50can indicate a distance that a device has traveled into a surgical site.Although there are two sets of demarcation lines 56 a, 56 b in theillustrated embodiment to indicate distance in, e.g., two differentunits of measurement, there can be any number of sets of demarcationlines.

The surgical system 10 can include one or more locking mechanisms tolock a position of the guide 20 (e.g., an angular and/or axial position)with respect to the sleeve 30. The locking mechanism can be removably orpermanently attachable to the sleeve 30, or it can be an integrallyformed feature of the sleeve 30. In the illustrated embodiment, thelocking mechanism is a trocar 40 that can be inserted into the innerlumen 32 of the sleeve 30. As shown in FIGS. 6A and 6B, the trocar 40can include an elongate shaft 42, a substantially pointed distal region44 and a handle 46. The pointed distal region 44 can be configured toextend distally beyond the distal end of the shaft 30 when the trocar 40is inserted fully into the shaft 30 to facilitate insertion of thesystem 10 into a surgical site. The handle 46 can have any size andshape configured to assist a user in gripping the trocar 40 andinserting the trocar 40 into a surgical site. The handle 46 of theillustrated embodiment is an elongate member that is configured toextend through a gap between arms 54 a, 54 b of the handle 50. In thisway, the handle 46 can serve as an indicator of a depth that the trocar40 has been inserted into a surgical site and/or can serve as a stop toprevent the trocar 40 from being inserted further distally into thesleeve 30 once the handle 46 abuts the proximal end of the sleeve 30.

The trocar 40 can have one or more passageways extending therethroughfor one or more surgical devices therein. The one or more passagewayscan extend through any cross-sectional portion and along any length ofthe trocar 40. As shown in FIG. 6B, the trocar 40 includes first,second, third, and fourth radial passageways 43 a, 43 b, 43 c, and 43 d,as well as a central passageway 45. Each of the passageways 43 a, 43 b,43 c, 43 d, and 45 can have dimensions and a cross-sectional shape thatis configured to slidably seat and/or to lock one or more surgicaldevices therein. For example, in the illustrated embodiment, the centralpassageway 45 has a diameter D_(W) that is larger than a diameter of adevice intended to be inserted only temporary into the bone, e.g., aK-wire, such that the K-wire can slide freely in and out of thepassageway 45. This can be particularly useful where, for example, theK-wire is inserted into a hole in the bone to serve as a guide for abone screw and is removed before insertion of the bone screw. However,it will be appreciated by a person skilled in the art that thepassageway 45 can have any dimension corresponding to any surgicaldevice configured to be inserted therethrough.

The passageways 43 a, 43 b, 43 c, 43 d, and 45 can be configured toengage a surgical device seated therein a variety of ways. In someembodiments, the dimensions of the passageway can be only slightlylarger than corresponding dimensions of a surgical device to fix thedevice therein by interference fit while still allowing the device toslide within the passageway when acted on by an external force thatexceeds a threshold force. In the illustrated embodiment, each of theradial passageways 43 a, 43 b, 43 c, and 43 d has a width W_(G) and alength L_(G) that are only slightly larger than the correspondingdimensions of a guide, e.g., the guide 20, to thereby create aninterference fit with the guide 20 while allowing for axial sliding ofthe guide 20 when acted on by an external force that exceeds a thresholdforce. Additionally or alternatively, walls of the passageways 43 a, 43b, 43 c, and 43 d can have gripping features to facilitate locking ofthe guide therein. By way of non-limiting example, the passageways 43 a,43 b, 43 c, and 43 d can have one or more features to prevent rotationof the guide 20, e.g., the passageways 43 a, 43 b, 43 c, and 43 d canhave one or more axial ridges protruding inwardly therefrom that alignwith corresponding channels extending axially along an exterior surfaceof the guide 20.

There can be any number of passageways extending through the trocar 40for seating any number, size, and shape of surgical devicestherethrough. As shown in FIG. 6B, the radial passageways 43 a, 43 b, 43c, and 43 d are disposed radially of the central passageway 45, at rightangles to one another. It will be appreciated by a person skilled in theart that the radial passageways 43 a, 43 b, 43 c, and 43 d can bearranged at any angle with respect to one another, to thereby allow fora guide passing therethrough to contact a target bone. The location ofthe radial passageways 43 a, 43 b, 43 c, and 43 d adjacent to anexternal rim of the trocar 40 can help to increase a lateral offset ofthe distal portion 22 of the guide 20 from a target location in the boneby a distance D_(T), which is the distance between the centralpassageway 45 and each of the radial passageways 43 a, 43 b, 43 c, and43 d. Specifically, a surgical device inserted through the centralpassageway 45 can be disposed at a distance D_(T) D_(G) away from thebony structure that is contacted by the distal portion 22 of the guide.The distance D_(T) can be adjusted to achieve the desired offset, andcan be either the same or different for each of the radial passageways43 a, 43 b, 43 c, and 43 d. Similarly, the relationship between D_(G)and D_(T) can vary and can be customized for a particular surgicalprocedure and/or to achieve a desired offset. By way of non-limitingexample, where the procedure allows for a large diameter sleeve 30, thedistance D_(T) can be larger than the distance D_(G). In general, thedistance D_(T) can be in a range of about 0.5 millimeters to about 20millimeters.

It will be appreciated by a person of skill in the art that any numberand type of locking mechanisms can be used to fix the guide 20 in placewithin the sleeve 30. By way of non-limiting example, the lockingmechanism can include a ridge or protrusion extending inwardly from awall of the lumen 32 of the sleeve 30. A recess corresponding in sizeand shape to the ridge or protrusion can be formed in the intermediateportion 24 of the guide 20, such that engagement between the ridge orprotrusion and the corresponding recess serves to lock the guide 20 inplace within the sleeve 30 at a fixed axial and/or angular position. Itwill be further appreciated by a person of skill in the art that thelocation of the protrusion or ridge and the recess can be reversed, suchthat the lumen 32 has a recess formed therein and the guide 20 has aprotrusion or ridge formed thereon. Other mechanisms or features forsetting the location of one component with respect to another can alsobe incorporated into the system 10 to facilitate locking a location ofthe guide 20 with respect to the sleeve 30. By way of non-limitingexamples, a locking mechanism can include various male and femalemembers incorporated into the guide 20 and sleeve 30 or an outsidecomponent configured to set a location of the guide 20 with respect tothe sleeve 30, e.g., a compression component, clamp, nut, etc.

Another exemplary embodiment of a system 100 for orienting one or moresurgical devices with respect to a bone is illustrated in FIGS. 7A-8C,with FIGS. 7A-7C illustrating the assembled system 100 and FIGS. 8A-8Cillustrating portions of the system, including a slotted sleeve 130 andan optional handle 150. The system 100 can include the slotted sleeve130 and a guide 120 that is configured to be inserted at least partiallyinto a lumen 132 of the sleeve 130 such that a distal, bone-engagingportion 122 of the guide 120 extends distally beyond a distal end of thesleeve 130. Thus positioned, the guide 120 can be configured to orientthe sleeve 130 and any devices passed therethrough at a desired distanceand orientation from a bony structure that is contacted by the distalportion 122 of the guide 120. At least an intermediate portion 124 ofthe guide 120 can be configured to be inserted into the lumen 132through a longitudinal slot 136 in a sidewall of the sleeve 130. In thisway, a distal, bone-engaging portion 122 of the guide 120 need not passthrough the sleeve 130 in order for the system 100 to be assembled asshown in FIGS. 7A-7C. This side-loading capacity of the sleeve 130 canbe particularly useful where, for example, the distal portion 122 of theguide 120 is too large to be passed through the sleeve 130.

Similar to the distal portion 22 of the guide 20, the distal portion 122of the guide 120 can be laterally offset from an intermediate portion124 of the guide 120 by a predetermined distance to help provide astabilizing offset from a bony structure contacted by the distal portion122. As shown in FIGS. 7A and 7C, the distal portion 122 is formed in aC-shape, which can enable the distal portion 122 to contact surfaces ofthe bony structure that are on an opposite side of the bony structurefrom a surface that is being operated on. In this way, the guide 120 canmore effectively grasp the bony structure and can thereby enhance thestability of the guide system 100.

Similar to the proximal portion 26 of the guide 20, the proximal portion126 of the guide 120 can have one or more direction indication featuresto indicate a direction of lateral offset of the distal portion 122. Asbest shown in FIG. 7C, the proximal portion 126 is bent in an oppositedirection from the lateral offset of the distal portion 122, such that auser viewing the proximal portion 126 can know that the distal portion122 is bent in an opposite direction when the distal portion 122 isdisposed within a patient's body or is not otherwise visible. Further,in some embodiments, the proximal portion 126 can be manipulated tochange an orientation of the distal portion 122. In the illustratedembodiment, the proximal portion 126 can be bent away from theintermediate portion 124 to facilitate gripping of the proximal portion126. When the intermediate portion 124 of the guide 120 is seated in thelumen 132, the proximal portion 126 can thus extend outside the slot 136and can be gripped by a user to manipulate the guide 120. Although theproximal portion 126 is bent away from the intermediate portion 124 byapproximately ninety degrees in the illustrated embodiment, it will beappreciated by a person skilled in the art that the proximal portion 126can extend at any angle to the intermediate portion 124, and can haveany one or more features to facilitate gripping.

Like the sleeve 30, the sleeve 130 can generally be configured to beinserted at least partially into a body of a patient. Accordingly, thesleeve 130 can have one or more features thereon to facilitate insertioninto the patient's body, e.g., teeth 133, on a distal end thereof tohelp pierce tissue. In some embodiments, at least a proximal portion ofthe sleeve 130 can be configured to remain outside the patient's body tothereby allow for manipulation of one or more surgical devices seatedtherein, as described in more detail below.

The sleeve 130 can have one or more slots, e.g., the slot 136, which canbe configured to allow for side-loading of one or more surgical devicestherethrough. In the illustrated embodiment, shown in FIGS. 8A-8C, theslot 136 is configured to allow for side-loading of the guide 120, andtherefore has dimensions that are slightly larger than correspondingdimensions of the guide 120. In particular, the slot 136 has a lengthL_(O) that is larger than a length of the intermediate portion 124 ofthe guide 120. However, it will be appreciated that the slot 136 canhave any length suitable for passing any portion of the guide 120therethrough. It will be further appreciated by a person skilled in theart that the slot 136 can be of any size and shape to facilitate theinsertion and/or subsequent manipulation of a particular medical device,and that the sleeve 130 can have any number of slots formed therein,either the same or different from one another.

In some embodiments, the slot 136 can be configured to orient the distalportion 122 of the guide 120 in a desired manner when the intermediateportion 124 of the guide 120 is seated within the lumen 132 of thesleeve 130. Where the proximal portion 126 of the guide is configured toextend outwardly through the slot 136, for example, the location of theslot 136 can determine the orientation of the distal portion 122.Specifically, the distal portion 122 of the guide 120 can extendradially outwardly from a sidewall of the sleeve 130 that is opposite tothe sidewall on which the slot 136 is formed. In still furtherembodiments, the slot 136 can be configured to orient the guide 120 inmore than one orientation. As shown in FIGS. 8A-8C, at least a proximalportion 138 of the slot 136 can extend at an angle to a distal portion139 of the slot 136, for example the proximal portion 138 can form anS-shape with the distal portion 139. Thus, where the guide 120 is seatedin the lumen 132 such that the proximal portion 126 of the guide 120extends through the slot 136, the guide 120 can be oriented in one oftwo different directions. First, where the proximal portion 126 of theguide 120 extends through the proximal portion 138 of the slot 136, asshown in FIGS. 7A-7C, the distal portion 122 of the guide 120 can extendin a first direction. Second, where the proximal portion 126 of theguide 120 extends through the distal portion 139 of the slot 136, thedistal portion 122 of the guide 120 can extend in a second direction,e.g., approximately ninety degrees from the first direction. A personskilled in the art will recognize a number of other configurations thatthe slot 136 can form without departing from the spirit of the presentdisclosure.

As mentioned above, in some embodiments at least the proximal portion138 of the slot 136 can be configured to remain outside the patient'sbody when at least a distal portion of the sleeve 130 is inserted intothe patient's body. In this way, a user can access the proximal portion126 of the guide 120 to manipulate the distal portion 122 of the guide120 while the distal portion 122 is within the patient's body, e.g., tomove the distal portion 122 between the first and second directions.

In some embodiments, a handle 150 can be attached to a proximal end ofthe sleeve 130, for instance to facilitate insertion of the sleeve 130into a patient's body. The handle 150 can be attached to the sleeve 130either permanently, for instance by being integrally formed with thesleeve 130, or it can be removably attached to the sleeve 130, forinstance by screws 152 a, 152 b. The handle 150 can be configured in avariety of ways to improve the user's ability to deliver and/or positionone or more surgical devices through the sleeve 130. In the illustratedembodiment, the handle 150 is a generally elongate member tapered upwardin the proximal direction and having a curved lip on a terminal,proximal end thereof to facilitate gripping of the handle 150.

The system 100 can further include a locking mechanism to fix the guide120 in place with respect to the sleeve 130, similar to lockingmechanisms described above. In some embodiments, the locking mechanismcan be a part of the sleeve 130, e.g., a latch or slot formed on a wallof the lumen 132 and being configured to snap into engagement with theguide 120. By way of non-limiting example, the proximal portion 138 ofthe slot 136 can function as the locking mechanism where the proximalportion 138 has a smaller width than a width of the distal portion 139.In such embodiments, the guide 120 can first be inserted into the sleeve130 such that the proximal portion 126 of the guide 120 extends throughthe distal portion 139 of the slot 136. The guide 120 can then be lockedinto place with respect to the sleeve 130 by sliding the guide 120proximally and rotating the guide 120 until the proximal portion 126 ofthe guide 120 passes through the proximal portion 138 of the slot 136.The relative dimensions of the proximal portion 126 of the guide 120 andthe proximal portion 138 of the slot 136 can be configured to providefor an interference fit therebetween. In still further embodiments, thelocking mechanism can be a separate component that is configured to beinserted into the lumen 132, for example through the slot 136 or througha second slot, or it can be configured in any other number of waysprovided for herein or otherwise known to those skilled in the art.

Any number, shape, and size of guides as described herein can be used toguide surgical devices into a bone. By way of non-limiting example,FIGS. 9A to 9F illustrate alternate embodiments of a distal portion of aguide as described herein. In each of the alternate embodiments, thedistal portion is bent away from an intermediate portion byapproximately a ninety degree angle, although it will be appreciated bya person skilled in the art that the distal portion can be bent away atany angle. The shape of the distal portion can be configured to alignwith a particular bony structure, e.g., the flat shape of the distalportion 22 a of FIG. 9A can be configured to align with a substantiallyflat bone surface, the concave curved shape of the distal portion 22 bof FIG. 9B can be configured to align with a convex bone surface, andthe V-shape of the distal portion 22 c of FIG. 9C can be configured toalign with a sharp or pointy bone surface. In the embodiment illustratedin FIG. 9D, the distal portion 22 d can have demarcations 23 d thereonfor measuring a distance from a bony structure to a target location inbone. In this way, a surgeon can adjust an offset of the guide 20 fromthe target location intraoperatively, e.g., using an endoscope to viewthe distal portion 22 d. In the embodiment illustrated in FIG. 9E, thedistal portion 22 e has a bulbous portion 25 e thereon for facilitatingengagement with an edge and/or a concave surface of a bone. In theembodiment illustrated in FIG. 9F, the distal portion 22 f has a hookshape, which can facilitate grasping one or more bony structures and/oraccessing surfaces of a bony structure that are on an opposite side ofthe bony structure that is being operated on, i.e., it is capable ofcontacting structures that are not otherwise directly accessible to thesurgeon. It will be appreciated by a person skilled in the art that thedistal portion 22 can have any one or more surface features thereon thatare configured to facilitate engagement with bone, e.g., the distalportion 22 can be made from a material having a gripping surface thereonthat is configured to frictionally engage bone.

Any one or more of the guides described herein can be used inconjunction with one another to help guide surgical devices. Forexample, up to four guides—either the same or different from oneanother—could extend through the four radial passageways 43 a, 43 b,43c, and 43 d of the trocar 40, such that up to four guides can be lockedin position in the sleeve 30 by the trocar 40 to thereby stabilize thesleeve 30 by bracing the sleeve 30 against up to four bony structures.The lateral offset of each of the guides can be the same or differentfrom one another, and generally can be in a range of about 1 millimeterto 50 millimeters. In this way, a position and orientation of the sleeve30 can be set with respect to multiple anatomical landmarks, which canbe located at varying distances from the sleeve 30. The use of more thanone guide can also enhance the stability of the sleeve 30 and/or canhelp to stabilize fractured bone that is contacted by distal portions ofeach of the guides.

In some embodiments, one or more guides can be included as part of asurgical kit for creating a stabilizing offset from one or more bonystructures. The surgical kit can include any of the guides as describedherein, for example the guides illustrated in FIGS. 2, 7A-7C, and 9A-9F.Each of the guides can be either the same or different from one anotherand can be customized to contact a particular bony structure. Similarly,each of the guides can have a lateral offset that is customized tostabilize the sleeve at a predetermined distance from each of the bonystructures contacted by the guides. By way of non-limiting example, thesurgical kit can be configured for use in a glenoid fixation procedure.The kit can include a first guide having a first lateral offset that isconfigured to contact the glenoid rim, and a second guide having asecond lateral offset that is configured to contact, by way ofnon-limiting examples, the coracoid process, the clavicula, the femurcondyle (femoral notch), the Eminencia, any allografts or autografts atthe surgical site, etc. Generally, guides having various sizes, shapes,and configurations, e.g., distal tips, can be included as part of asurgical kit to allow for use with different patient anatomies, e.g.,male vs. female and adult vs. child, and for use in differentprocedures, e.g., repairs near the glenoid rim vs. repairs elsewhere inthe body.

The guide systems disclosed herein can generally be used to positionsurgical devices at a predetermined location and orientation withrespect to one or more bones. In an exemplary embodiment, a guide systemcan be used to form a bone hole at a predetermined distance and at apredetermined orientation with respect to an edge of a bone.

In use, a sleeve of the guide system can be inserted into a body of apatient in accord with customary surgical procedures, which can includeopen surgery or minimally invasive surgery (e.g., using one or moreaccess cannulae). A guide can be inserted into the sleeve such that adistal, bone-engaging portion of the guide extends distally beyond thesleeve and/or a proximal, stop portion of the guide abuts a proximal endof the sleeve. In some embodiments, where the guide is passed distallythrough the sleeve, the distal portion of the guide can be in acompressed configuration, in which the distal portion is substantiallyaligned with an intermediate portion of the guide. Once the distalportion of the guide advances beyond a distal end of the sleeve, it canassume an expanded configuration in which the distal portion islaterally offset from the intermediate portion by a predetermineddistance. Using the laterally offset distal portion as a guide, asurgeon can locate a bony structure, such as an edge of a bone, and canthereby align the sleeve at a desired distance and/or at a desiredorientation with respect to the edge of the bone. One or more directionindication features on the proximal portion of the guide can indicate adirection of the offset of the distal portion to help a surgeon bracethe guide against the edge of the bone. For example, as in theillustrated embodiment of FIG. 2, the direction of the major axis A_(M)of a loop formed by the proximal portion 26 of the guide 20 cancorrespond to a direction of offset of the distal portion 22 of theguide 20. Where the lateral offset of the distal portion can be adjustedintra-operatively, e.g., with the distal portion 22 d of FIG. 9D, asurgeon can adjust the offset of the distal portion while viewing thedistal portion with, e.g., an endoscope. In some embodiments, once theguide is oriented in the desired position, it can be locked in placewithin the sleeve by a locking mechanism, e.g., a trocar advanceddistally into the sleeve. In still further embodiments, the abovedescribed process can be repeated with more than one guide, such thatmultiple guides extend through the sleeve and/or are locked with respectto the sleeve.

With the sleeve being oriented at the desired location and orientation,a surgeon can pass one or more surgical devices through the sleeveand/or through the trocar that can optionally be disposed within thesleeve. By way of non-limiting example, a K-wire can be advanceddistally through a second passageway in the trocar, which can bedisposed radially inward of the first passageway to thereby createadditional offset of the K-wire from the distal portion of the guide.One or more depth indication features of the sleeve can indicate a depththat the K-wire is inserted into a surgical site to thereby ensure thatthe K-wire is advanced to a desired depth. The guide and/or the trocarcan then be removed from the sleeve, leaving the K-wire in place toserve as a guide for one or more surgical devices, e.g., a bone implant.Surgical repair can then proceed according to accepted surgicaltechniques.

A person skilled in the art will appreciate that the above describedsteps of the exemplary surgical method can be performed in any order. Byway of non-limiting example, the trocar can be inserted into the sleevebefore the guide. Once the trocar is set within the sleeve, the guidecan be advanced through a first passageway of the trocar by applying adistally-directed force to the guide. When the guide has been advancedto the point that distal portion of the guide extends beyond the distalend of the sleeve, the force can be removed and the guide can thus belocked in place within the trocar by interference fit within the firstpassageway. Additionally or alternatively, in some embodiments, theguide can be inserted into the patient's body before the sleeve. Thesleeve can then slide over the guide through the incision and into thepatient's body. In still further embodiments, the guide and the sleevecan be inserted approximately simultaneously into the patient's body,for instance by inserting them separately and then assembling them onceinserted (provided the configuration of the system allows such aconstruction), or by assembling the guide with the sleeve beforeinsertion into the patient's body.

The guide system can be used, for example, in an exemplary glenoidfixation procedure illustrated in FIG. 10, which is a simplified view ofthe anatomy of the shoulder blade SB with various soft tissue structures(including skin) removed for ease of illustration. Moreover, althoughcannulae for use in minimally surgical procedures are not illustrated(for ease of viewing), a person skilled in the art will understand thatsuch devices can be used in a glenoid fixation procedure. FIG. 10depicts the surgical system 10 fully assembled, with the guide 20 beinglocked in place by the trocar 40 within the sleeve 30. As shown, thedistal portion 22 of the guide 20 is braced against the glenoid rim GR,thereby spacing a cross-sectional center of the sleeve 30 at a distanceD_(G)+D_(T) away from the edge of the glenoid rim. The proximal portion26 indicates a direction of offset of the distal portion 22 to help thesurgeon properly orient the system 10. Once the system 10 is assembledas shown in FIG. 10, a K-wire (not shown) can be inserted through thecentral passageway 45 of the trocar 40 to a desired depth, as indicatedby demarcation lines 56 a, 56 b on the sleeve 30. Then, the guide 20and/or the trocar 40 can be removed from the sleeve 30, leaving theK-wire in place to serve as a guide for a hole-forming instrument thatforms a hole in the bone. An anchoring element such as a screw can thenbe inserted into the hole, and fixation can proceed according toaccepted surgical techniques.

A person skilled in the art will appreciate that the present inventionhas application in conventional minimally-invasive and open surgicalinstrumentation as well application in robotic-assisted surgery.

The devices disclosed herein can also be designed to be disposed ofafter a single use, or they can be designed to be used multiple times.In either case, however, the device can be reconditioned for reuse afterat least one use. Reconditioning can include any combination of thesteps of disassembly of the device, followed by cleaning or replacementof particular pieces and subsequent reassembly. In particular, thedevice can be disassembled, and any number of the particular pieces orparts of the device can be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thedevice can be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those skilled in the art will appreciate that reconditioningof a device can utilize a variety of techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of the presentapplication.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical method, comprising: inserting a sleevethrough an opening in a patient's body and adjacent to a bone; insertinga guide through the opening in the patient's body; placing the guide inan inner lumen of the sleeve such that a distal tip of the guide extendsdistally beyond a distal-most end of the sleeve, the distal tip having aguide placement surface; rotating the guide such that its distal tip isdisposed outside of a diameter defined by a diameter of the sleeve;inserting a trocar distally through the inner lumen to secure a fixedlocation of the guide with respect to the sleeve after the distal tip ofthe guide extends distally beyond the distal-most end of the sleeve;placing the guide placement surface against an edge of the bone suchthat the inner lumen of the sleeve is proximate to a bore formationlocation on the bone that is offset from the edge of the bone; andforming a bore in the bone at the bore formation location.
 2. Thesurgical method of claim 1, wherein an outer surface of the trocarengages an outer surface of the guide to secure the fixed location ofthe guide with respect to the sleeve.
 3. The surgical method of claim 2,further comprising inserting a K-wire distally through the trocar andinto the bone.
 4. The surgical method of claim 1, further comprisingadjusting a location of the distal tip with respect to a main body ofthe guide after the guide has been passed distally through the sleeve.5. The surgical method of claim 1, wherein the bone is a scapula and theedge of the bone is the glenoid rim.
 6. The surgical method of claim 1,wherein the guide comprises an elongate body having an uncannulatedinterior throughout its length.
 7. A surgical method, comprising:inserting a sleeve through an opening in a patient's body and adjacentto a bone; inserting a guide through the opening in the patient's body;placing the guide in an inner lumen of the sleeve such that a distal tipof the guide extends distally beyond a distal-most end of the sleeve,the distal tip having a guide placement surface; placing the guideplacement surface against an outermost surface of the bone such that theinner lumen of the sleeve is proximate to a surgical site on the bonethat is offset from the outermost surface of the bone; and passing oneor more surgical devices through the sleeve, with at least one surgicaldevice of the one or more surgical devices being passed outside of anouter surface of the guide.
 8. The surgical method of claim 7, furthercomprising forming a bore in the bone at the surgical site.
 9. Thesurgical method of claim 7, further comprising securing a fixed locationof the guide with respect to the sleeve after the distal tip of theguide extends distally beyond the distal-most end of the sleeve.
 10. Thesurgical method of claim 7, wherein the at least one surgical device ofthe one or more surgical devices is a trocar.
 11. The surgical method ofclaim 10, further comprising engaging an outer surface of the guide withan outer surface of the trocar to secure a fixed location of the guidewith respect to the sleeve.
 12. The surgical method of claim 7, whereinthe at least one surgical device of the one or more surgical devices isa K-wire.
 13. The surgical method of claim 7, further comprisingrotating the guide such that its distal tip is disposed outside of adiameter defined by a diameter of the sleeve.
 14. The surgical method ofclaim 7, wherein the bone is a scapula and the outermost surface of thebone is the glenoid rim.
 15. The surgical method of claim 7, wherein theguide comprises an elongate body having an uncannulated interiorthroughout its length.
 16. A surgical method, comprising: inserting asleeve through an opening in a patient's body and adjacent to a bone;inserting a guide into the sleeve, the guide having a distal portionthat is biased into an expanded configuration, the distal portion beingdisposed in a compressed configuration when the distal portion isdisposed in the sleeve; advancing the guide through the sleeve such thatthe distal portion extends distally beyond a distal-most end of thesleeve, causing the distal portion to move from the compressedconfiguration to the expanded configuration; securing a fixed locationof the guide with respect to the sleeve after the distal portion of theguide extends distally beyond the distal-most end of the sleeve; andplacing a guide placement surface of the distal portion of the guideagainst an edge of the bone such that the inner lumen of the sleeve isproximate to a surgical site on the bone that is offset from the edge ofthe bone.
 17. The surgical method of claim 16, further comprisingforming a bore in the bone at the surgical site.
 18. The surgical methodof claim 16, further comprising passing one or more surgical devicesthrough the sleeve, with at least one surgical device of the one or moresurgical devices being passed outside of an outer surface of the guide.19. The surgical method of claim 18, wherein the at least one surgicaldevice of the one or more surgical devices is a trocar.
 20. The surgicalmethod of claim 18, further comprising engaging an outer surface of theguide with an outer surface of the at least one surgical device of theone or more surgical devices to secure a fixed location of the guidewith respect to the sleeve.
 21. The surgical method of claim 18, whereinthe at least one surgical device of the one or more surgical devices isa K-wire.
 22. The surgical method of claim 16, wherein an effectivewidth of the distal portion of the guide is less than or equal to adiameter of the guide when the distal portion is disposed in thecompressed configuration, and the effective width of the distal portionof the guide is greater than a diameter of the guide when the distalportion is disposed in the expanded configuration.
 23. The surgicalmethod of claim 16, wherein placing the guide placement surface againstan edge of the bone such that the inner lumen of the sleeve is proximateto a surgical site on the bone that is offset from the edge of the boneresults in a direction indication feature located on a proximal portionof the guide that indicates a direction of offset of the guide placementsurface.
 24. The surgical method of claim 23, wherein the directionindication feature comprises a loop that is formed on a same side of theguide as the distal portion, the loop having a diameter that is largerthan a diameter of the sleeve to prevent the loop from passing throughthe sleeve.
 25. The surgical method of claim 16, wherein the bone is ascapula and the edge of the bone is the glenoid rim.
 26. The surgicalmethod of claim 16, wherein the guide comprises an elongate body havingan uncannulated interior throughout its length.